122 Questions
Who can refuse medical care and/or transport?
Competent adult patient
Under what conditions can a minor refuse medical care and/or transport?
Competent emancipated minor
Who may be considered incompetent to refuse care?
Person with severe medical condition affecting decision-making
What is the primary purpose of the refusal of care procedure?
To address situations where a patient refuses evaluation, treatment, and/or transportation
Who can accept responsibility on behalf of a parent for refusing medical care for a minor?
An adult present and willing to sign the patient refusal form with verbal consent
Under what conditions can diabetic patients sign a Patient Refusal Form?
Lucidity, acceptable blood glucose levels, immediate access to food, and meeting refusal criteria
Who is responsible for medical direction at the destination facility or the agency?
The physician at the destination facility or the agency’s Medical Director
Under what circumstances should high-risk refusals require consultation with medical direction?
Involving minors, refusal of care representing significant risk, or refusal after administration of IV medication
What should be determined before refusal of care for a single patient?
The patient's ability to make informed decisions
What should be provided to the patient after they sign the 'Refusal of Care' form?
All of the above
What is the purpose of the Health and Safety committee developed by the Fire Chief’s Association of Broward County (FCABC)?
To promote safety and health in the workplace.
Which organization has recognized BHAP as a world standard of care for first responders?
Both a and b
What types of incidents are referred to as Debilitating Critical Incidents (DCI) for BHAP response?
All of the above
What should be done if the patient or responsible party will not sign the release?
Document this refusal on the EMS Run Report.
What is the purpose of BHAP?
For firefighter mental health/wellness and crisis intervention.
What should be done if possible when dealing with patients?
Leave patients in the care of family, friends, or responsible parties.
Name one organization that has embraced the BHAP model according to the text.
International Association of Fire Chiefs (IAFC)
What should be done after a 'Refusal of Care' form is signed?
It must be witnessed including legibly printed name, contact information, and signature of witness.
When is small group defusing recommended after a critical incident?
Within the first 12 hours
When is small group debriefing recommended after a critical incident?
12-72 hours post-critical incident occurs
What is the primary focus of Crisis Management briefing?
Assessment and information
What does Florida Statute 401.30(4) (e) protect during a CISM intervention?
"Confidential and privileged communication"
What is the primary role of the Peer Support program for first responders?
Provide emotional/mental wellness support and trained empathetic/active listening
What is the main responsibility of the Chaplain in the BHAP activation process?
Pastoral/spiritual crisis intervention
What do Evaluated Recovery Centers provide for first responders?
Fixed facilities that provide first responder specific treatment programs for substance abuse, PTSD, and other co-occurring behavioral health issues
What is the goal of Family Support programs for first responders' families?
Enhance the caregiver’s knowledge of stress injuries/mental health related issues specific to the first responder and develop strategies to manage conflict
What is a key requirement for effective insurance coverage for first responders?
Inclusive of first responder specific providers and highest level of service while limiting potential impedances to accessing clearly identified first responder specific resources
What is one of the responsibilities of Trained Clinician Response Team (CRT) for first responders?
Trained in first responder specific culture and treatment.
What is one way Retiree Support Programs can benefit retired first responders?
Mental wellness programs extended to include retirees who may continue to suffer from job related stress.
What should be provided by Employee Assistance Programs for first responders?
Confidential emotional/mental wellness support and trained empathetic/active listening
Who should be notified to initiate a BHAP Team response?
Duty Officer
What information does the duty officer provide when activating the CISM?
Agency name, type of incident, number of members involved, call-back contact name and number
Who receives the information and informs the BHAP Clinical Director of the incident?
BHAP Team Coordinator
What dictates the type of response by the BHAP Team Coordinator?
How early the BHAP is activated and the nature of the incident
What is the color of the paper on which the Do Not Resuscitate Order (DNRO) form should be printed?
Yellow
Who must sign the Do Not Resuscitate Order (DNRO) form and patient identification device to make them valid?
The patient's physician and the patient or their healthcare surrogate
What is the only approved form for a Do Not Resuscitate Order (DNRO) in the State of Florida?
Florida DNRO form
What is the purpose of the patient identification device that is part of the Do Not Resuscitate Order (DNRO) form?
To provide a convenient and portable DNRO which travels with the patient
What action should EMS take upon presentation of a completed Florida Do Not Resuscitate Order Form (DH Form 1896)?
Withhold or withdraw cardiopulmonary resuscitation
What should be done if there is a DNRO/POLST/MOST/MOLST form from another State presented by the patient or family?
Contact Medical Control as soon as possible for direction
What color should be used for duplicating DH Form 1896 for Do Not Resuscitate Order (DNRO)?
The shade of yellow does not have to be an exact duplicate.
What is required for a Do Not Resuscitate Order (DNRO) form to be valid?
The signature of the patient's physician and either the patient or their healthcare surrogate.
What should be done if the patient's clothing has a puncture?
Use a different part of the garment to start cutting
What should be done with removed clothing?
Left with the patient or turned over to law enforcement personnel
What should be done if the patient relates any information relating to the crime while in transit to the medical facility?
Inform law enforcement personnel at once
What should NOT be done with any object at the scene or after leaving the crime scene?
Move, take, or handle with medical equipment, dressings, bandages, or other supplies
Who can revoke a Do Not Resuscitate Order (DNRO) according to the text?
The patient or the patient's health care surrogate, proxy, or court-appointed guardian
What information must be documented in the EMS Run Report if a witness is used to identify the patient for the DNRO form?
The full name of the witness, address, and telephone number, and their relationship to the patient
What care should the EMS provider provide during transport of a patient with a DNRO form?
Comforting, pain-relieving, and any other medically indicated care, short of respiratory or cardiac resuscitation
How can a Do Not Resuscitate Order (DNRO) be revoked according to Section 765.104, F.S.?
In writing, by physical destruction, by failure to present it, or by orally expressing a contrary intent
What does POLST stand for in the context of EMS protocols and end-of-life planning?
Patient Orders for Life Sustaining Treatment
What is the primary emphasis of POLST in end-of-life care?
Patient wishes honoring
In which situations are EMS guidelines for determining death applicable?
Trauma victims and patients with chest trauma
Which form ensures that patient wishes are honored and reduces medical errors in end-of-life care?
POLST
Under what conditions may EMS request entry into a crime scene?
To determine the patient's life status
What is the primary purpose of the POLST form in end-of-life care?
To ensure patient wishes are honored
What is emphasized in the POLST paradigm?
Patient's autonomy and shared decision-making
Who are POLST forms intended for?
Patients with serious illness or frailty only
Who is responsible for modifying the assignment for an Air Rescue response?
Uniformed Fire Department Officers
In which situation may Air Rescue response be necessary?
Level 2 trauma patient with a ground transport time of greater than 30 minutes
Who should be dispatched for an Air Rescue assignment as per standard procedure?
One engine company and one rescue
When may additional units be needed for an Air Rescue assignment?
When the assigned unit requires additional personnel to secure the HS site
What is a key consideration for requesting Air Rescue for patient transport?
Weather conditions
What information must on-scene personnel communicate to Air Rescue as quickly as possible?
Patient status and weight
What is a requirement for the landing zone for Air Rescue?
Free from potential safety hazards
How should a patient be prepared for transport by Air Rescue?
Secured to a long spine board using the cross-strap method
What should personnel do upon Air Rescue's arrival on scene?
Not approach the aircraft
What should be done with sheets, blankets, and IV poles before approaching the helicopter?
Remove them from the patient and stretcher
What should ground crews announce if a hazard is identified during the helicopter's final approach to the landing zone?
'Abort. Abort. Abort'
Who must ensure that no bystanders approach the aircraft during landing, patient loading, and take-off?
Designated marshaller
What is not necessary to have at a landing zone for Air Rescue?
A hose line pulled and charged
What should personnel inform the patient about before loading them onto a helicopter for transport?
Noise, heat, and wind levels will be high
What is the purpose of the Mass Casualty Incident protocol?
To efficiently triage, treat, and transport victims of mass/multiple-casualty incidents
How is an Active Assailant different from an Active Shooter?
An Active Assailant uses means other than firearms to kill people in a confined area
What does ASHER stand for in the context of mass casualty incidents?
Active Shooter Hostile Event Response
When is the Mass Casualty Incident protocol applicable?
For everyday MCI when the number of injured exceeds the capabilities of the first-arriving unit as well as for large-scale MCIs
What is the purpose of the Rescue Task Force?
Initiate triage and provide immediate lifesaving treatment
How are victims prioritized during triage?
By color coded ribbons
What should be done with the 'walking wounded' at the incident site?
Direct them to one location away from the incident
Who may be designated as officers as additional units arrive?
Triage, Treatment, Transport, Staging, Medical Branch, Landing Zone/Heli-spot, Extrication, Hazardous Materials (hazmat)
How are Mass Casualty Incidents classified?
By different levels depending on the number of victims
What should Command do if an MCI response needs to be adjusted?
Downgrade or upgrade the assignments at any time
Under what circumstances should trauma transport criteria be reported to a trauma center?
When trauma center(s) are overwhelmed and need additional resources
What should be considered when announcing an MCI?
The general category (e.g., trauma, hazardous materials, smoke inhalation)
What is the primary purpose of Ballistic Protection Equipment (BPE)?
Protection against ballistic threats, stabbing, fragmentation, or blunt force trauma
What is the function of a Casualty Collection Point (CCP)?
Temporary location for gathering, triage, and medical stabilization of casualties
What does Unified Command (UC) involve?
An authority structure shared by individuals from all responding organizations
What is the responsibility of a Contact Team/Law Enforcement Entry Team?
Locating and neutralizing the threat
What do Zones at Active Shooter Hostile Events designate?
"Hot Zone, Warm Zone, and Cold Zone", each based on safety and hazard levels
What is the recommended response for an MCI Level 1 (5-10 victims)?
1 EMS Supervisor
In an MCI Level 2 (11-20 victims), how many EMS Shift Supervisors are recommended?
2 EMS Shift Supervisors
What is the responsibility of Medical Control (Medcom/MRCC) upon notification of an MCI?
Gather information about each hospital's capability and relay it to the Transport Officer or Medical Communication Officer
What should be considered on a large-scale incident according to the text?
Sending a Hospital Coordinator to each hospital to assist with communications
Who is responsible for maintaining communication with Medical Control to assure proper victim transport information and destination?
Medical Communications Coordinator
What is the responsibility of the Medical Supply Coordinator?
Acquiring and maintaining control of all medical equipment and supplies
Who is responsible for managing all activities within the staging area?
Staging Officer
What should the Medical Communication Coordinator relay to Medical Control when units are prepared to transport victims?
The unit transporting, number of victims, their priority, any victims with special needs
Who determines the most appropriate facility for victim transport in conjunction with Medical Control?
Medical Communication Coordinator
What does the Staging Officer coordinate with the Transport Officer?
Designation of a location for victim loading and the best route to the area
What is the responsibility of the Medical Supply Coordinator in relation to equipment on transporting vehicles?
Assure necessary equipment is available on the transporting vehicle
Who is responsible for maintaining a Hospital Transportation Log #5B?
Medical Supply Coordinator
What is the responsibility of the Triage Officer in a mass casualty incident?
Coordinating with Command and supervising on-scene personnel
In an MCI Level 4, how many Mass Transit Buses are required?
2
What is the primary responsibility of Medical Branch officers in a mass casualty incident?
Ensuring notification of Medical Control
How many MCI Task Forces are required in an MCI Level 5?
10
What do officers involved in a mass casualty incident NOT have the responsibility of doing?
Ensuring proper allocation of resources
How many ALS Transport Units are required in an MCI Level 3?
8
What is the primary responsibility of the Transport Officer in a mass casualty incident?
Supervising the coordination of victims and maintaining records relating to victim identification
What is NOT required in an MCI Level 5?
3 Shift Supervisors
What is NOT part of the responsibilities for officers involved in a mass casualty incident?
Overseeing the medical treatment of victims
How many Suppression Unit Strike Teams are required in an MCI Level 4?
1
What is included in the MCI Kits for Responder Vehicles?
Trauma Tourniquets
How many triage tags are included in the MCI Kits?
Fifty (50)
What is included in the MCI FOGs, logs, and associated paperwork for each officer?
Twelve (12) items
In the START triage method, what color is assigned to a victim with no respiration after a head tilt?
Black
What is the color assigned to a victim with respirations over 30/min or respiratory distress in the START triage method?
Red
For infants who are developmentally unable to walk, which triage algorithm should be used according to the text?
JumpSTART
Who developed the START Triage system according to the text?
Newport Beach Fire Rescue and Hoag Hospital
In the JumpSTART Triage system, what color is assigned to a victim with no respiration after head tilt and no peripheral pulse?
Black
What is the color assigned to a victim with stable RPM/walking in the JumpSTART Triage system?
Green
What physiological differences in children necessitate adaptation of the standard START triage method according to the text?
Differences in respiratory rate
What adaptation is indicated for children 8 years of age or younger or those victims with anatomical or physiological features of a child in the age group?
The same parameters (RPM) are utilized as in adults.
Study Notes
Refusal of Medical Care and Transport Guidelines
- Guidelines specify that individuals may not refuse medical care or transport under certain conditions, including altered consciousness, suicidal behavior, severely altered vital signs, mental disability, intoxication, and being younger than 18.
- If a parent or guardian of a minor with traumatic injuries cannot make it to the scene, they may request by phone that their child not be transported to the hospital.
- An adult present and willing to sign the patient refusal form can accept responsibility on behalf of the parent, with verbal consent, and leave the child in their care.
- These interactions should be well-documented in the electronic patient care report (ePCR).
- Patients who refuse to be transported to the closest appropriate facility and insist on being transported elsewhere should be considered to be refusing transport.
- Implied consent may be used for treating and transporting incompetent individuals.
- The physician at the destination facility or the agency’s Medical Director is responsible for medical direction.
- High-risk refusals, such as those involving minors, refusal of care representing significant risk, or refusal after administration of IV medication, require consultation with medical direction.
- Diabetic patients may sign a Patient Refusal Form under specific conditions, including lucidity, acceptable blood glucose levels, immediate access to food, and meeting refusal criteria.
- The procedure does not allow for more than one refusal on a single EMS Run Report, but individuals who refuse ALL assistance can be combined on a single report.
- All measures should be taken to convince the patient to consent, including enlisting the help of family or friends.
- For a single patient, mental status, extent and history of injury, and physical assessment should be determined before refusal of care.
EMS Protocols and End-of-Life Planning
- Nonphysician staff or absent physician orders are not acceptable for EMS decisions
- Florida will adopt the POLST (Physician Orders for Life Sustaining Treatment Paradigm)
- POLST emphasizes patient wishes, advance care planning, and shared decision-making
- POLST form ensures patient wishes are honored and reduces medical errors
- POLST is for patients with serious illness or frailty, not healthy patients
- Several states use POLST, MOLST, MOST, and POST forms for end-of-life care
- EMS guidelines for determining death include conditions like lividity and rigor mortis
- Special considerations for trauma victims and patients with penetrating or blunt chest trauma
- Law enforcement involvement in crime scenes and EMS response protocols
- EMS may request entry into a crime scene to determine the patient's life status
- Minimum EMS personnel should enter a crime scene to minimize disturbance
- Protocols for resuscitation and treatment in crime scene situations
Mass Casualty Incident and Active Shooter Hostile Events Response Procedures
- Ballistic Protection Equipment (BPE) is personal protective equipment (PPE) to protect against ballistic threats, stabbing, fragmentation, or blunt force trauma.
- Casualty Collection Point (CCP) is a temporary location for gathering, triage, and medical stabilization of casualties.
- Complex Coordinated Attack involves multiple asymmetric attack modes and coordinated attacks on multiple locations.
- Concealment refers to protection from observation, providing or not providing protection from the threat.
- Contact Team/Law Enforcement Entry Team is a team of officers tasked with locating and neutralizing the threat.
- Cover provides protection from firearms or hostile weapons.
- Rescue Task Force (RTF) is a combination of fire, EMS, and law enforcement personnel providing force protection and victim extraction.
- THREAT is an acronym highlighting the importance of initial actions to control hemorrhaging.
- Unified Command (UC) is an authority structure shared by individuals from all responding organizations.
- Zones at Active Shooter Hostile Events include Hot Zone, Warm Zone, and Cold Zone, each designated based on safety and hazard levels.
- The first-arriving unit at a mass casualty incident will establish Command, perform a size-up, request response levels, and establish a staging area.
- In case of an active shooter/assailant incident, Unified Command with Law Enforcement should be established, and liaisons for Fire Department and Law Enforcement can interact to transfer information between agencies.
Mass Casualty Incident Response Structure
- MCI Level 3 involves 21-100 victims and requires 8 ALS Transport Units, 4 Suppression Units, 3 Shift Supervisors, and a Command Vehicle.
- MCI Level 4, for 101-1000 victims, necessitates 5 MCI Task Forces, 2 ALS Transport Strike Teams, 1 Suppression Unit Strike Team, 2 BLS Transport Strike Teams, and 2 Mass Transit Buses.
- MCI Level 5, for more than 1000 victims, requires 10 MCI Task Forces, 4 ALS Transport Strike Teams, 2 Suppression Unit Strike Teams, 4 BLS Transport Strike Teams, and 4 Mass Transit Buses.
- The responsibilities for officers involved in a mass casualty incident include establishing command, determining MCI level, designating staging areas, and ensuring proper security and traffic control.
- Medical Branch officers are responsible for coordinating with Command, supervising on-scene personnel, and ensuring notification of Medical Control.
- The Triage Officer is responsible for organizing and prioritizing victims based on the severity of their injuries.
- The Treatment Officer is responsible for overseeing the medical treatment of victims and ensuring the proper allocation of resources.
- The Transport Officer supervises the coordination of victims and maintains records relating to victim identification, injuries, mode of transportation, and destination.
Test your knowledge about the refusal of care procedure and the proper evaluation, treatment, and transportation of patients. Learn about situations in which a patient refuses evaluation, treatment, and/or transportation to a medical facility.
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